Herbrecht R, Nivoix Y, Fohrer C, Natarajan-Amé S, Letscher-Bru V
Department of Haematology and Oncology, Hôpital de Hautepierre, 67098 Strasbourg, France.
J Antimicrob Chemother. 2005 Sep;56 Suppl 1:i39-i48. doi: 10.1093/jac/dki223.
For many years, amphotericin B and flucytosine have been the only antifungal agents for invasive fungal infections. Amphotericin B was the standard of care for most of these infections. However, its use was often associated with low efficacy and poor tolerance. Fortunately, the antifungal armamentarium has increased during the past two decades with the addition of several new agents. In addition to itraconazole and fluconazole, lipid formulations of amphotericin B, voriconazole, caspofungin and micafungin have arrived on the market. Other agents are expected to be licensed shortly (anidulafungin, posaconazole). These various antifungal agents differ in their spectrum, pharmacokinetic profile, route of administration, efficacy in clinical trials, safety profile, drug-drug interactions and, importantly, their cost. There is no longer a unique standard agent for all or nearly all invasive fungal infections but a real choice among several agents. The characteristics of these new agents are reviewed to help clinicians in their decision to select an antifungal agent for their patients.
多年来，两性霉素B和氟胞嘧啶一直是治疗侵袭性真菌感染的仅有的抗真菌药物。两性霉素B是大多数此类感染的治疗标准药物。然而，其使用往往疗效不佳且耐受性差。幸运的是，在过去二十年中，随着几种新药物的加入，抗真菌药物库有所增加。除了伊曲康唑和氟康唑外，两性霉素B的脂质制剂、伏立康唑、卡泊芬净和米卡芬净已上市。其他药物预计不久也将获得许可（阿尼芬净、泊沙康唑）。这些不同的抗真菌药物在抗菌谱、药代动力学特征、给药途径、临床试验疗效、安全性、药物相互作用方面存在差异，重要的是，它们的成本也不同。对于所有或几乎所有侵袭性真菌感染，不再有单一的标准药物，而是在几种药物之间有了真正的选择。本文对这些新药物的特点进行综述，以帮助临床医生为患者选择抗真菌药物时做出决策。
